Brunner Alexander, Müller Jochen, Regazzoni Pietro, Babst Reto
Department of Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland.
J Foot Ankle Surg. 2012 May-Jun;51(3):299-307. doi: 10.1053/j.jfas.2012.01.011. Epub 2012 Feb 15.
The purpose of this study was to present a surgical technique of open reduction and internal fixation of displaced intra-articular calcaneal fractures with 3 AO mini-fragment plates and to evaluate the clinical and radiological outcome of a consecutive group of patients after a mean follow-up of 41.7 months. A series of 54 patients (16 women and 38 men) with 62 calcaneal fractures were treated over a period of 6.5 years. Forty-five patients with 50 calcaneal fractures were completely clinically and radiologically followed up. Clinical follow-up included assessment of range of motion, pain according to a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score, and the short-form 36 health survey. Radiological follow-up included plain axial and lateral radiographs and measurement of the Böhler's angle and Gissane's angle. Independent Student's t test and paired Student's t test were used alongside the chi-square test to compare clinical and radiological data and score values between different groups of patients. Eleven patients showed breakage of the osteosynthesis material during the healing process and 2 patients sustained deep wound infection requiring revision surgery. At the final follow-up all fractures had healed. The average range of motion was supination 26.4° (range 0° to 50°; SD 11.6°), pronation 15.4° (range 0° to 30°; SD 6.4°), dorsal extension 14.3° (range -10° to 30°; SD 8.0°), and plantarflexion 39.6° (range 20° to 65°; SD 11.7°). Patients with OTA type C4 fractures achieved significantly lower supination (p < .01) and plantarflexion (p < .01) compared with other fracture types. The mean visual analog scale pain score was 3.6 (range 0 to 8; SD 2.3) points, average American Orthopaedic Foot and Ankle Society hindfoot score was 70.8 (range 33 to 100; SD 17.1) points, and the mean short-form 36 score was 60.98 (range 22.9 to 93.0; SD 18.4) points. The mean postoperative Böhler's angle was 28.9° (range 8° to 38°; SD 7.1°), which decreased to 23.6° (range 4° to 34°; SD 8.7°) at the final follow-up, and the mean postoperative Gissane's angle was 108.6° (range 80° to 140°; SD 11.8°), which finally decreased to 102.4° (range 72° to 126°; SD 12.7°). No statistically significant differences regarding Böhler's and Gissane's angles were found between different OTA fracture types. In conclusion, the presented surgical technique was found to provide comparable and adequate reduction of OTA type C2-C4 injuries based on statistically insignificant differences in radiographic measures of postoperative fracture reduction. Greater limitation in subtalar motion was observed in OTA type C4 fractures in comparison with less severe fractures (p < .01).
本研究的目的是介绍一种使用3块AO微型接骨板对移位的关节内跟骨骨折进行切开复位内固定的手术技术，并评估一组连续患者在平均随访41.7个月后的临床和影像学结果。在6.5年的时间里，共治疗了54例患者（16例女性和38例男性）的62处跟骨骨折。45例患者的50处跟骨骨折得到了完整的临床和影像学随访。临床随访包括评估活动范围、根据视觉模拟量表评估疼痛程度、美国矫形足踝协会后足评分以及36项简短健康调查。影像学随访包括普通的轴位和侧位X线片以及测量Böhler角和Gissane角。使用独立样本t检验和配对样本t检验以及卡方检验来比较不同患者组之间的临床和影像学数据及评分值。11例患者在愈合过程中出现内固定材料断裂，2例患者发生深部伤口感染需要进行翻修手术。在最后一次随访时，所有骨折均已愈合。平均活动范围为：内翻26.4°（范围0°至50°；标准差11.6°），外翻15.4°（范围0°至30°；标准差6.4°），背伸14.3°（范围-10°至30°；标准差8.0°），跖屈39.6°（范围20°至65°；标准差11.7°）。与其他骨折类型相比，OTA C4型骨折患者的内翻（p <.01）和跖屈（p <.01）明显更低。平均视觉模拟量表疼痛评分为3.6分（范围0至8分；标准差2.3分），平均美国矫形足踝协会后足评分为70.8分（范围33至100分；标准差17.1分），平均36项简短健康调查评分为60.98分（范围22.9至93.0分；标准差18.4分）。术后平均Böhler角为28.9°（范围8°至38°；标准差7.1°），在最后一次随访时降至23.6°（范围4°至34°；标准差8.7°），术后平均Gissane角为108.6°（范围80°至140°；标准差11.8°），最终降至102.4°（范围72°至126°；标准差12.7°）。不同OTA骨折类型之间在Böhler角和Gissane角方面未发现统计学上的显著差异。总之，基于术后骨折复位的影像学测量差异无统计学意义，所介绍的手术技术被发现能够对OTA C2 - C4型损伤提供相当且充分的复位。与较轻微骨折相比，OTA C4型骨折的距下关节活动受限更明显（p <.01）。
